Paul Carleton Ryals, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

16789 Issued in MN

Practice address

7362 University Ave NE
Suite 101
Fridley, MN 55432-3142

Phone

(763) 503-3981

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1336152644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6529 44TH AVENUE NORTH",
            "address_2": "6529 44TH AVE NORTH",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "55428",
            "telephone_number": "763-537-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7362 UNIVERSITY AVE NE",
            "address_2": "SUITE 101",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323142",
            "telephone_number": "763-503-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYALS",
        "first_name": "PAUL",
        "middle_name": "CARLETON",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "16789",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6255168",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246058100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "8G624DI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas F Rolewicz, M.D.
• Royalty Health Care Inc.
• Katie Rubedor-Green, PSYD
• Michael Rudolph, MD
• Jaclyn Rust, PHARMD
• Ryze Access Support LLC
• Ryze Inc
• Julie Sabin, M.A, LPCC, RPT-S
• Katrina Marie Sacchetti, PHARMD
• Alan E. Sadowsky, M.D.

• Clinical Social Worker in Fridley, MN
• Providers in Fridley, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.